RESEARCH LETTER SARS -CoV -2 infection in patients with rheumatic diseases 1 margin of error, 5%).Data distribution was evaluated using the Kolmogorov-Smirnov test.Data were presented as mean (SD) or median (interquartile range).Groups were compared using the t test and the Mann-Whitney test.The parameters were evaluated using the Pearson χ 2 test and logistic regression analysis.A P value of less than 0.05 was considered significant.All statistical data were analyzed using STATA 11, license number 30110532736 (StatSoft Inc, Tulsa, Oklahoma, United States). ResultsOut of 450 patients scheduled for a visit in the outpatient clinic, 210 were included in the analysis.Demographic and clinical characteristics of patients with RD are summarized in TAbLE 1. Patients were divided into 4 groups according to the type of RD.The rheumatoid arthritis (RA) group included seropositive and seronegative RA cases (n = 61 [29%]).In the spondyloarthritis (SpA) group, we included patients with ankylosing spondylitis, nonradiographic axial SpA, psoriatic arthritis, synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome (n = 83 [39.5%]).The connective tissue disease (CTD) group comprised individuals with systemic lupus erythematosus, polymyositis, dermatomyositis, Sjögren syndrome, antiphospholipid syndrome, eosinophilic fasciitis, scleroderma, polyarteritis nodosa, and polymyalgia rheumatica (n = 60 [28.6%]).The last group (other RD) included gouty arthritis and juvenile idiopathic arthritis cases (n = 6 [2.9%]).Symptoms of COVID -19 occurred in 53 patients (96.4%) with a positive result of a SARS -CoV -2 infection test.The reported symptoms included loss of smell in 37 individuals (67.2%), weakness in 37 (67.2%),loss of taste in 34 (61.8%),headache in 23 (41.8%), muscle pain in 21 (38.2%),cough in 20 (36.4%), fever in 16 (29.1%),joint pain in 17 (30.9%),and dyspnea in 16 patients (29.1%).

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Sochaczewska D, Czeszyńska M, Fischer K, Bobrowska-Snarska D. Infants of mothers with systemic connective tissue disease – serological and clinical status in the first year of life; a pilot study. Pediatria Polska - Polish Journal of Paediatrics. 2021;96(1):31-37. doi:10.5114/polp.2021.104826. APA Sochaczewska, D., Czeszyńska, M., Fischer, K., & Bobrowska-Snarska, D. (2021). Infants of mothers with systemic connective tissue disease – serological and clinical status in the first year of life; a pilot study. Pediatria Polska - Polish Journal of Paediatrics, 96(1), 31-37. https://doi.org/10.5114/polp.2021.104826 Chicago Sochaczewska, Diana, Maria Beata Czeszyńska, Katarzyna Fischer, and Danuta Bobrowska-Snarska. 2021. "Infants of mothers with systemic connective tissue disease – serological and clinical status in the first year of life; a pilot study". Pediatria Polska - Polish Journal of Paediatrics 96 (1): 31-37. doi:10.5114/polp.2021.104826. Harvard Sochaczewska, D., Czeszyńska, M., Fischer, K., and Bobrowska-Snarska, D. (2021). Infants of mothers with systemic connective tissue disease – serological and clinical status in the first year of life; a pilot study. Pediatria Polska - Polish Journal of Paediatrics, 96(1), pp.31-37. https://doi.org/10.5114/polp.2021.104826 MLA Sochaczewska, Diana et al. "Infants of mothers with systemic connective tissue disease – serological and clinical status in the first year of life; a pilot study." Pediatria Polska - Polish Journal of Paediatrics, vol. 96, no. 1, 2021, pp. 31-37. doi:10.5114/polp.2021.104826. Vancouver Sochaczewska D, Czeszyńska M, Fischer K, Bobrowska-Snarska D. Infants of mothers with systemic connective tissue disease – serological and clinical status in the first year of life; a pilot study. Pediatria Polska - Polish Journal of Paediatrics. 2021;96(1):31-37. doi:10.5114/polp.2021.104826.

Based on the present literature, in March 2016, new recommendations of the American Academy of Ophthalmology for ophthalmic screening tests in patients treated with chloroquine and hydroxychloroquine were published. These recommendations emphasized the fact that toxicity is related to the dose calculated by real weight. The recommended hydroxychloroquine and chloroquine doses have been limited. It is no longer recommended to calculate the cumulative dose of chloroquine to establish the risk of toxicity. Kidney failure and the use of tamoxifen are proven risk factors of ocular complications in these patients. The screening agenda was established and available diagnostic methods were evaluated. Screening in patients treated with chloroquine derivatives may prevent an irreversible complication-toxic retinopathy. The present recommendations warn against making premature decision on medicine withdrawal, especially in the light of the most recent studies on their beneficial systemic influence. This paper systematizes the information on ophthalmological screening in chloroquine derivatives users.

Background and objectives Vascular disorders are a well recognised clinical problem in systemic lupus erythematosus (SLE). This preliminary study was designed to evaluate the association between cerebral circulation changes, carotid arteries involvement as well as nailfold capillaroscopy (NC) abnormalities and immunologic/inflammatory markers, classical atherosclerosis risk factors and organ involvement in SLEpatients. Materials and methods The study was performed in 30 SLE patients. Bilateral transcranial doppler (TCD) monitoring over the middle cerebral arteries according to the criteria of the International Consensus Group on Microembolus Detection was performed using two 2-MHz probes of the pulsed Doppler system MultiDop-T Digital (DWL Compumedics). MRI scans of the brain were carried out using a 1.5-T scanner GE Discovery 450 (GE Healthcare). Detection of carotid stenosis was performed using 3D contrast-enhanced MR angiography. Carotid intima-media thickness (cIMT) was measured with B-mode ultrasound. NC was done using Zeiss device. More than 100 variables were taken into account including cytokines, inflammatory markers, autoantibodies, classical risk factors for atherosclerosis and selected organ manifestations. Statistical analysis was performed with chi2 Yates, chi2 Pearson, rank Spearman correlations tests and logistic regression analysis. Results Factors which significantly correlated with analysed vascular changes including microemboli in TCD, ischaemic changes in MRI and NC abnormalities, were thrombocytopenia (r = 0.47, p = 0.01), C-reactive protein (CRP) (r = 0.51, p = 0.0039) and antiphospholipid antibodies (aPLs) (r = 0.55, p = 0.0015). There was significant association between vascular endothelial growth factor (VEGF) and IL-6 and high cIMT (r = 0.36, p = 0.0492, r = 0.41, p = 0.0239, respectively) as well as NC abnormalities, especially megacapillaries presence (r = 0.38, p = 0.0415, r = 0.42, p = 0.0226, respectively). Additionally, patients with changes in NC significantly more frequently were dyslipidemic (r = 0.56, p = 0.0015), hypertensive (r = 0.41, p = 0.0252) and unveiled high titers of anti-dsDNA (r = 0.37, p = 0.0492) and cardiac involvement (r = 0.38, p = 0.0441). There was also important positive correlation between cIMT and NC abnormalities (r = 0.40, p = 0.0300) as well as microemboli in TCD (r = 0.44, p = 0.0211). Finally, microemboli in TCD were associated with MRI ischaemic changes (r = 0.45, p = 0.0177). Conclusions NC and cIMT provide the optimal protocol to screen SLE patients for cardiovascular risk. CRP, VEGF, IL-6, aPLs and anti-dsDNA seem to be crucial pathogenic factors in micro- and macrovascular impairment development in SLE. Patients with higher cIMT and aPLs should undergo TCD for cerebrovascular risk assessment.

Introduction. The aim of our study was to determine the electrocardiography (ECG) and holter abnormalities among patients with dermatomyositis (DM) or polymyositis (PM). Material and methods. We examined 19 patients with PM and 11 patients with DM (23 females) and 30 healthy subjects (22 females). Mean disease duration was 6.5 ± 4.7 years. ECG parameters (QRS, PQ, P wave, conduction disturbances) and heart rate variability data, QT/QTc, ventricular extra beats, creatine kinase, aldolase and lactate dehydrogenase activities were assessed. Results. We did not observe any statistically signifi cant differences in parameters assessing the autonomic system function, the QT/QTc, ventricular rhythm disorders. Intraventricular conduction disturbances were observed in 16.6% of patients with PM/DM. Finally, there were signifi cant differences when comparing enzyme activities. Higher enzyme activities in DM/PM did not correlate with the diurnal variability of cardiac rhythm. Conclusions. This suggests no tendency of DM and PM to involve the autonomic nervous system. Conduction disturbances in DM and PM affect mainly the His-Purkinje system.

Zapalenie skórno-mięśniowe (dermatomyositis – DM) częstowspółistnieje z chorobami nowotworowymi, dlatego rozważa sięuznanie go za zespół paranowotworowy. Mechanizmy patogenetyczneodpowiedzialne za to współistnienie nie są jednak w pełnipoznane. Pierwsze pięć lat od rozpoznania DM to okres największegoryzyka wystąpienia nowotworu złośliwego, chociaż chorobanowotworowa może ujawnić się przed DM lub w trakcie jego rozpoznania.Typy nowotworów złośliwych stwierdzane u osób z DMsą zbliżone do występujących w populacji ogólnej, najczęściej spotykasię nowotwory jajnika, płuc, przewodu pokarmowego, sutkai chłoniaki nieziarnicze.We współwystępowaniu DM i nowotworu dużą rolę odgrywa wiek.Zależność ta jest istotnie większa u starszych chorych w porównaniuz młodszymi, a największa częstość zachorowań występujew wieku 40–69 lat.Wpracy przedstawiono przypadek 60-letniej chorej na DM i nowotwórsutka w wywiadzie oraz ze współistniejącymi nowotworamijajnika i macicy. Pacjentkę poddano leczeniu operacyjnemu i chemioterapii.W czasie 11-miesięcznej obserwacji od czasu zakończenialeczenia stan chorej był dobry, zaprzestano leczenia farmakologicznego.Nawrót objawów odpowiadających DM był powodemponownej diagnostyki, która wykazała obecność zmian budzącychpodejrzenie, że są to zmiany przerzutowe raka jajnika do tkankipodskórnej brzucha.

BACKGROUNDMean vascular resistance in the retrobulbar arteries of SLE patients and the statistical relationship between its parameters and the presence of certain antibodies were determined.MATERIAL/METHODSForty-three eyes of 43 SLE female patients aged 46.28+/-8.45 years with disease duration of 10.03+/-7.96 years were examined. Physical and ophthalmic examinations with assessments of the immunological markers ANA/IgG-IgM, aCL, anti-beta2GPI, LA, and anti-dsDNA antibodies were performed. color Doppler imaging (CDI) was used in the OA, CRA, LPCA, and MPCA vessels. The vascular resistance indices (RIs) were compared with those of 43 eyes of 43 female controls. Covariance and multiple regression analysis with chi squared, Pearson, Shapiro-Wilk, and Levene tests were used in the statistical analysis (significance levels at p<or=0.01 and p<or=0.05).RESULTSSignificantly increased RIs in the OA, CRA, LPCA, and MPCA were recorded. aCL, abeta2GPI, and LAC correlated significantly with increased RI in the CRA. SLE diagnosis significantly correlated with RI in the OA and PCAs. Significant relationship between age and RI in the CRA and LPCA was detected.CONCLUSIONSRetrobulbar resistance disturbances were detected in SLE patients by CDI. SLE diagnoses and presence of aPLs antibodies were associated with an increased resistivity index in ophthalmic and retino-choroidal vessels.

The opinion that systemic lupus erythematosus (SLE) is a young people disease translates into its rare diagnosing in subjects in their 6th decade of life and older. The variability of neuropsychiatric disorders that may be the first symptoms of the disease suggest the need for their in-depth diagnostics and treatment. Chorea is one of the rarest neuropsychiatric symptoms of SLE. It may be present in an early stage of the disease and it is one of the most common motor disorders in SLE. The presented case of diagnosing SLE in a 79-year-old male shows the importance of individual and thorough assessment of the clinical picture of every patient regardless of his/her age and gender. In the discussed case the clinical course of the disease denies common opinions about the picture of SLE in the elderly.

Eosinophilic fasciitis is a rare disease classified by some authors to scleroderma like syndromes. It occurs the most frequently between the second and the sixth decade of life, mainly in Caucasians. It usually appears in young males and exceptionally in children. It has an abrupt onset. The etiology of this disease is unknown. Hardening of the skin and subcutaneous tissue, eosinophilia in peripheral blood and hypergammaglobulinaemia are the most characteristic features of the disease. Inflammation and fibrosis of the fascia that spreads over into the deeper layers of skin and muscles are typical for its histological picture. The infiltration is composed of the lymphocytes, plasmocytes and eosinophiles. The involvement of internal organs in the course of the disease is rare. The course of eosinophilic fasciitis can be different. Prognosis is generally good, however recurrences of the disease can happen. The treatment with nonsteroidal anti-inflammatory drugs and/or with glucocorticosteroids is not satisfactory in some cases. It is not uncommon that intense immunosuppressive treatment is required.

Muscle weakness with elevation of muscle enzymes may be a predominant manifestation of many diseases, among them myositis and hypothyroidism.Between 1997 and 2005, polymyositis (PM) or dermatomyositis (DM) was diagnosed in 28 patients (7 males, 21 females) referred to our Department of Rheumatology. Coexistence of hypothyroidism and poly/dermatomyositis was established in seven patients (25%), all of them women. Five of them fulfilled the diagnostic criteria for PM, two for DM. The mean age at the time of diagnosis was 46.1 years (40-54 years). Four patients were diagnosed with chronic autoimmune thyroiditis, in two patients the autoimmune etiology was probable, whereas one patient was diagnosed with hypothyroidism secondary to strumectomy for follicular adenoma. We present and compare signs and symptoms characteristic for hypothyroidism and poly/dermatomyositis. Hypothyroidism may be masked by symptoms of poly/ dermatomyositis especially when the course of myositis is rapid.Every patient suspected of poly/dermatomyositis should be tested for thyroid hormone levels to exclude hypothyroidism with muscle weakness arising from the polymyositis-like syndrome or alternatively to confirm the coexistence of hypothyroidism and poly/dermatomyositis.

Antiphospholipd syndrome (APS) is a disease characterised by venous and arterial thrombosis or recurrent foetal loss, which are associated with antiphospholipid antibodies or/and lupus anticoagulant. Clinical symptoms ofAPS are assocciated with presence of noninflammatory thrombosis ocluding arteries or venes. Symptoms of APS are often very dramatic what can be illustrated by the presented case of 40 year patient. At the age of 25 after a miscarriage the patient developed tetraparesis and motor aphasia in the course of thrombosis in central nervous system vessels. In physical examination besides neurological symptoms reticular livedo was found on the trunk and limbs. Serological tests have revealed presence of high titre of IgG and IgM anticardiolipin antibodies and lupus anticoagulant (LA). CT examination revealed hypodensic foci in left parietal lobe, and abnormal EEG findings were observed in fronto-temporal leads of left hemisphera of brain. At that point the patient did not meet the criteria of connective tissue diseases, including lupus. The diagnosis of primary APS was suggested. The patient received anti-aggregation treatment and also immunosuppressive drugs (azathioprine and prednison) due to progression of neurological manifestations. 3 years later, the second pregnancy ended in the 27th week with intrauterine fetal death. During the 3rd pregnancy, 2 years afterwards, the patient was treated with heparin, aspirin and intravenous immunoglobulin. The pregnancy finished with a successful delivery at term, the newborn was in good condition. During the following pregnancy the symptoms of preeclampsia occurred at 36/37th week but the newborn was delivered in a good condition after a caesarean section. At the age of 36 patient developed ischemic brain stroke with left-side hemiparesis inspite of anti-aggregation and immunosupressive (prednison and azathioprine) treatment. At that time homogenic type antinuclear antibodies (ANA) 1:2560, anti-beta2-glycoprotein antibodies (beta2-GPI), aCL antibodies in medium titer and thrombocytopenia were found. The patient was treated with heparin, cyclophosphamide and methyloprednisolon intravenously. During rehabilitation process gradual improvement of cognitive functions, speech and motorical functions was observed. Recently high titre of ANA and recurent thrombocytopenia < 100,000/mm3 were present. Maybe during the further follow-up, 14 years after the first symptoms of APS, the patient will develop full blown symptoms of SLE.